Kines Shoulder

8/13/2019 Kines Shoulder

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KINESIOLOGY OF THSHOULDER

Wayan Budi Aryawan


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THE SHOULDER GIRDLE

Shoulder complex dibentuk oleh 7 sendi

Saling bergantung untuk menghasilkan gerakan ritm

Semua bagian bekerja sebagai tim untuk meghasilgerakan yg terkoordinasi

Gangguan pada salah satu bagian dapat menyebabkgangguan pada sendi-sendi yg lain


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OSTEOLOGY

CLAVICLE :

S Shaped & Roughly cylindrical

Medial end fits poorly with themanubrium sterni

Lateral end fits in with theacromion


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OSTEOLOGY

HUMERUS:

The head: permukaan articular yg halus drhumerus

Lesser tuberosity: a marked prominence on theanterior surface

Greater tuberosity

Intertubercular grooves: memisahkan lesser andgreater tuberosity

Anatomical neck

Surgical neck: tempat yg sering terjadinyafraktur


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THE JOINTS

1. Glenohumeral joint

2. Suprahumeral joint3. Acromioclavicular joint

4. Scapulocostal joint

5. Sternoclavicular joint

6. Costosternal joint7. Costovertebral joint

1

2

3

4

5


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Glenoumeral joint

The joint : Dibentuk oleh ball shaped of head humerus dan shallow con

glenoid fossa

Triaxial joint

Perbedaan yg mecolokAngular value of the head of humerus = 153

Angular value of glenoid fossa = 75

Tidak stabilagar lebih stabil :Upward direction of the glenoid fossa

Fibrous ring at the perimeter of the fossaglenoid labrum


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Glenoumeral joint


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Glenohumeral Joint

Synovial Lining Synovial lining throughtout the joint inside the capsule

Rotator cuff muscle are woven into the capsule

The Bursae :

Banyak bursae yg terdapat di shoulder joint, bbrp diantaranberhubungan atau merupakan prolongasi dr synovial sac


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Glenohumeral Joint

the bursae Subacromial, subdeltoid,

subcoracoid

Provide the gliding mechanismfor the muscle

The bursae only gains clinicalsignificance when they becomeinflammedBursitis


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Glenohumeral Joint

Muscles and Nerves Prime mover :

1. M. Deltoid (n.axillary;C5,C6)

2. M. Supraspinatus (n.suprascapular;C4,C5,C6)

3. M. Infraspinatus (n.suprascapular;C4,C5,C6)

4. M. Teres minor (n.axillary;C5,C6)

5. M. Subscapularis (n.subscapular sup&inf;C5,C6)

Rotator cuff combined with deltoidarm abduction

Rot

c

mu
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Muscles


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Glenohumeral Joint

The Movement Gliding of two incongrous surface

Requires simultaneous abduction of the arm with the deprethe humeral head.

The arm abduction: passively to 120, active 90

> 120 abduction bloked by the humeral impinging upon theprocess and the coracoaromial ligament.

Full abduction (180) results from the rotation of the scapulScapulohumeral Rhythym


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Glenohumeral Joint


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Suprahumeral Joint

Not a true joint

Mrp arkus yg dibentuk oleh ligament ygmengubungkan coracoid and acromialprocess

Prevent :

1. Trauma from above glenohumerl joint

2. Upward dislocation of the humerus

Many sensitive tissue enclosed withinin abd, humeral head must pass undercoracoacromial process w/o pinchingsensitive tissue


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Scapulothoracic Joint

Scapula moves in gliding manner upon thoracic walltype movement :

Translatory

Rotatory

Prime Mover : m. Trapezius and serratus anterior

Trapezius (N. XI/N. Accesorius) 3 parts

Upper: pulls the scapula upward. Middle: fix the scapula during the abduction

Lower: pull medial border of the spine down and in

Upper + lower combinedelevating glenoid fossa

Usually are combination

of both
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Serratus anterior

pulls the scapula forward

Long thoracic nerve of Bell (C5,C6,C7)

Upper trapezius+lower trapezius+serratus anterior: rotation & elethe glenoid fossa

Other muscles act on scapula

Levator scapulae

Rhomboid major

Rhomboid minor

Elevate medial border of scapula

Downward rotation of glenoid fossa

(dorsal scapular nerve, C5)
http://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/levator%20scapula.swfhttp://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/rhomboid%20major.swfhttp://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/rhomboid%20minor.swfhttp://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/rhomboid%20minor.swfhttp://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/rhomboid%20major.swfhttp://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/levator%20scapula.swf


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Latissimus Dorsi Extensor, internal rotator, adductor Thoracodorsal nerve (C7,C8)

Pectoralis Major Arm adduction Upper(clavicular) portion; lateral pectoral nerve Lower(sternal) portion; medial pectoral nerve

Pectoralis Minor Depress the shoulder; medial pectoral nerve

Teres major Extensor,internal rorator of arm, abductor of humerus Lower subscapular nerve (C5,C6)
http://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/latissimus%20dorsi.swfhttp://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/pectoralis%20major.swfhttp://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/pectoralis%20minor.swfhttp://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/teres%20major.swfhttp://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/teres%20major.swfhttp://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/pectoralis%20minor.swfhttp://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/pectoralis%20minor.swfhttp://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/pectoralis%20major.swfhttp://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/pectoralis%20major.swfhttp://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/latissimus%20dorsi.swf


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Acromioclavicular Joint

Plane joint connecting the outer

end of the clavicle with to anteriormedial portion of acromial process

Reinforced by strong superior andinferior acromioclavicularligamentsprevent the posteriordislocation

The scapula attached to claviclethrough coracoclavicularligamentprevent scapula fromrotating about theacromioclavicular joint


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Acromioclavicular Joint

As the scapula rotates to elevate the glenoid fossa, itthe clavicle through the attachment of coracoclaviculigaments

Rotation of clavicle occurs in arm elevation >90

The first 30 of clavicle elevation occurs at sternoclav

joint

The next 30 is the result of rotation of the clavicle along axis.


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Sternoclavicular Joint

Formed by sternal end of the clavicle attaching to the superportion of manubrium of the sternum and the cartilage of t

Costoclavicular ligament

Stabilize the clavicle aginst muscle action

Acts as the fulcrum for all motion of the shoulder girdle.

Acts as ball and socket joint. Muscles:

Subclavius: depressing the clavicle, raising the first rib protectinsubclavian vessel during fracture of clavicle

Sternocleidomastoid: pull the head, flex the neck, turn the face to


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Sternoclavicular Joint


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Biceps Mechanism

Biseps& tricepsbiarticularmuscles

Triceps : extend the shoulder

Biceps : Foreerm supination, elbow flexion

Assist the anteriordeltoid in

forward flexion of the shoulder The motion of biceps tendon in

bicipital groove only when thereis movement of theglenohumeral joint
http://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/biseps.swfhttp://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/triceps%20long%20head.swfhttp://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/triceps%20long%20head.swfhttp://localhost/var/www/apps/conversion/tmp/files/GetBodySmart/upper%20extermity/biseps.swf


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Shoulder Girdle Movement

Arm abductionscapulohumeral rhythym

Every 15: 10 at glenohumeral joint, 5scapula rotation

Only 60 of humeral abduction is possible with arm internal

In externally rotated:90(active),120(passive)

Full elevation (180) requires 60 of scapular rotation


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Pathomechanics of the Paralysis of Shoulder

Paralisis seratus anterior :

Medial winging of scapula

Develops especially when thearm carried forward

Paralisis trapezius

Lateral winging


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TERIMA

KASIH

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Kines Shoulder